Tip 2 Diyabetli Hastalarda Nötrofil/Lenfosit Oranı ve Sistemik İnflamasyon İndeksinin Mikroalbuminüri ile İlişkisinin Değerlendirilmesi

Abstract

Amaç: Çalışmamızda tip 2 diyabetli (T2DM) hastalarda sistemik inflamasyon indeksi (SII) ve nötrofil/lenfosit oranının mikroalbuminüri gelişimi üzerindeki prediktif etkisini araştırmak amaçlandı. Materyal ve Metot: Retrospektif olarak planlanan çalışmaya Haziran/2023–Eylül/2023 tarih aralığında xxx hastanesi endokrinoloji polikliniğine başvurmuş olan 18-70 yaş arası 140 T2DM hastası alındı, dosya ve laboratuvar verileri tarandı. Vaka grubuna (grup 1) spot idrar mikroalbumin/kreatinin oranı 30-300 mg/gün aralığında olan 70 T2DM hastası alındı. Kontrol grubuna (grup 2) mikroalbuminürisi olmayan 70 T2DM hastası alındı. Hastaların açlık kan şekeri (AKŞ), kreatinin, glomeruler filtrasyon hızı (GFR), HbA1c, LDL ve HDL kolesterol, trigliserid, hemogram, spot idrarda albumin/kreatinin, tam idrar tetkiki parametreleri kaydedildi. Hasta dosyalarındaki verilerden yaşı, cinsiyeti, boyu, kilosu, vücut kitle indeksi (VKİ) ve kullandıkları medikal tedavileri kaydedildi. Laboratuvar sonuçlarına göre NLO ve SII hesaplandı(NLO=nötrofil sayısı/lenfosit sayısı oranı; SII=trombosit sayısıxnötrofil sayısı/lenfosit sayısı oranı). İstatistiksel analizler iki grup üzerinden yapıldı. Bulgular: Gruplar arasında yaş, cinsiyet dağılımı, VKİ, hemogram parametreleri, kreatinin, LDL ve HDL kolesterol gibi biyokimyasal parametreler açısından anlamlı farklılık saptanmadı. Mikroalbüminürisi olan T2DM’li hastaların AKŞ ve HbA1c değeri mikroalbüminürisi olmayan T2DM’li hastalardan istatiksel anlamlı yüksek iken GFR istatatistiksel anlamlı düşük bulundu (p<0,05). Gruplar NLO ve SII açısından kıyaslandığında istatistiksel anlamlı farklılık gözlenmedi. Mikroalbuminürisi olmayan hastalar SGLT-2 inhibitörü kullanımına göre değerlendirildiğinde SGLT-2 inhibitör tedavisi alan hastalarda NLO yüksek bulundu (p<0,05). Diğer grup ilaçlar açısından kıyaslandığında NLO ve SII ile ilişki saptanmadı. Sonuç: Çalışmamızın sonucunda mikroalbuminürisi olan T2DM’ li ve olmayan T2DM’ li hastalar arasında NLO ve SII arasında anlamlı fark saptanmadı. Mikroalbuminürisi olmayan ve SGLT-2 inhibitörü kullanan T2DM hastalarda NLO’ nun istatistiksel anlamlı yüksek olduğu saptandı. Sonuç olarak diyabetik hastalarda nefropati gelişiminin erken dönem belirteci olarak kullanılabilen bu parametrelerin, diğer inflamasyon belirteçleri ve farmakolojik ajanlarla olan etkileşimlerinin değerlendirileceği daha geniş hasta popülasyonunda yapılacak prospektif çalışmalar gereklidir.

Keywords

• diyabetik nefropati
• mikroalbuminüri
• inflamasyon

Evaluation of the Relationship of Neutrophil/Lymphocyte Ratio and Systemic Inflammation Index with Microalbuminuria in Patients with Type 2 Diabetes

Abstract

Objectives: The aim of our study was to investigate the predictive effect of the systemic inflammation index (SII) and neutrophil/lymphocyte ratio (NLR) on the development of microalbuminuria in patients with type 2 diabetes mellitus (T2DM) Materials and Methods: A total of 140 patients aged 18-70 with T2DM who presented to the endocrinology outpatient clinic of xxx hospıtal between June 2023 and September 2023 were included in this retrospectively planned study. Patient files and laboratory data were screened. In the case group (group 1) 70 T2DM patients with spot urine microalbumin/creatinine ratio between 30-300 mg/g were included. In the control group (group 2), 70 T2DM patients without microalbuminuria were included. Fasting blood sugar (FBS), creatinine, glomerular filtration rate (GFR), HbA1c, LDL and HDL cholesterol, triglycerides, complete blood count, spot urine albumin/creatinine, and full urine analysis parameters were recorded. Patient data including age, gender, height, weight, body mass index (BMI), and medical treatments were also noted from patient files. Neutrophil/lymphocyte ratio (NLR) and systemic inflammation index (SII) were calculated based on laboratory results (NLR=neutrophil count/lymphocyte count ratio; SII=platelet count×neutrophil count/lymphocyte count ratio). Statistical analyses were performed on the two groups Results: There was no significant difference between the groups in terms of age, gender distribution, BMI, hemogram parameters, creatinine, LDL and HDL cholesterol, and other biochemical parameters. However, statistically significant differences were observed between T2DM patients with microalbuminuria and those without microalbuminuria in terms of fasting blood sugar (FBS) and HbA1c levels, which were higher in patients with microalbuminuria, while GFR was found to be significantly lower (p<0,05). When comparing groups based on NLR and SII, no statistically significant differences were observed. Among patients without microalbuminuria, those receiving SGLT-2 inhibitor therapy had higher NLR values (p<0,05). However, there was no association between NLR, SII, and other group medications. Conclusions: Our study found no significant difference in NLR and SII between patients with and without microalbuminuria in T2DM. However, among T2DM patients without microalbuminuria who were using SGLT-2 inhibitors, NLR was significantly higher. In conclusion, further prospective studies involving a larger patient population are needed to evaluate these parameters, which can serve as early indicators of nephropathy development in diabetic patients, along with their interactions with other inflammatory markers and pharmacological agents.

Keywords

• diabetic nephropathy
• microalbuminuria
• inflammation

References

1. 1. Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect. 2020;10(2):98.
2. 2. Abdul Basith Khan M, Hashim MJ, King JK, Govender RD, Mustafa H, Al Kaabi J. Epidemiology of type 2 diabetes—global burden of disease and forecasted trends. J Epidemiol Glob Health. 2020;10(1):107-11.
3. 3. Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge AW, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281.
4. 4. Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci Rep. 2020;10(1):1-11.
5. 5. Thipsawat S. Early detection of diabetic nephropathy in patient with type 2 diabetes mellitus: A review of the literature. Diabetes Vasc Dis Res. 2021;18(6):14791641211058856.
6. 6. Gross JL, De Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005;28(1):164-76.
7. 7. Samsu N. Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment. Biomed Res Int. 2021;2021:1-10.
8. 8. Duran-Salgado MB, Rubio-Guerra AF. Diabetic nephropathy and inflammation. World J Diabetes. 2014;5(3):393.

9. 9. Donate-Correa J, Luis-Rodríguez D, Martín-Núñez E, Tagua VG, Hernández-Carballo C, Ferri C, et al. Inflammatory targets in diabetic nephropathy. J Clin Med. 2020;9(2):458.
10. 10. Assulyn T, Khamisy‐Farah R, Nseir W, Bashkin A, Farah R. Neutrophil‐to‐lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes. J Clin Lab Anal. 2020;34(7):e23259.
11. 11. Huang Q, Wu H, Wo M, Ma J, Fei X, Song Y. Monocyte–lymphocyte ratio is a valuable predictor for diabetic nephropathy in patients with type 2 diabetes. Medicine. 2020;99(19):e20190.
12. 12. Jaaban M, Zetoune AB, Hesenow S, Hessenow R. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as novel risk markers for diabetic nephropathy in patients with type 2 diabetes. Heliyon. 2021;7(7):e07371.
13. 13. Zhang J, Zhang R, Wang Y, Wu Y, Li H, Han Q, et al. Effects of neutrophil–lymphocyte ratio on renal function and histologic lesions in patients with diabetic nephropathy. Nephrology (Carlton). 2019;24(11):1115-21.
14. 14. Kawamoto R, Ninomiya D, Kikuchi A, Akase T, Kasai Y, Kusunoki T, et al. Association of neutrophil-to-lymphocyte ratio with early renal dysfunction and albuminuria among diabetic patients. Int Urol Nephrol. 2019;51(3):483-90.
15. 15. Uwaezuoke SN. The role of novel biomarkers in predicting diabetic nephropathy: a review. Int J Nephrol Renovasc Dis. 2017;10:221-231.
16. 16. Wan H, Wang Y, Fang S, Chen Y, Zhang W, Xia F, et al. Associations between the neutrophil-to-lymphocyte ratio and diabetic complications in adults with diabetes: a cross-sectional study. J Diabetes Res. 2020;2020:1-8.
17. 17. Huang W, Huang J, Liu Q, Lin F, He Z, Zeng Z, et al. Neutrophil–lymphocyte ratio is a reliable predictive marker for early‐stage diabetic nephropathy. Clin Endocrinol (Oxf). 2015;82(2):229-33.
18. 18. Shashikala MD. Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio: A screening tool for diabetic nephropathy and an alternative to assessing glycemic control. Natl J Physiol Pharm Pharmacol. 2022;12(10):1719.
19. 19. Guo W, Song Y, Sun Y, Du H, Cai Y, You Q, et al. Systemic immune-inflammation index is associated with diabetic kidney disease in type 2 diabetes mellitus patients: Evidence from NHANES 2011-2018. Front Endocrinol (Lausanne). 2022;13:1071465.
20. 20. Akha AAS. Aging and the immune system: An overview. J Immunol Methods. 2018;463:21-26.
21. 21. Varol E, Bas HA, Aksoy F, Ari H, Ozaydin M. Relationship between neutrophil–lymphocyte ratio and isolated low high-density lipoprotein cholesterol. Angiology. 2014;65(7):630-3.
22. 22. Eren MA, Cindoğlu Ç, Gökçe BD, Gökçe A, Sabuncu T. Tip 2 diyabetli hastalarda dapagliflozin tedavisinin trombosit fonksiyonları ve inflamasyon üzerine etkisi. Uludağ Üniv Tıp Fak Derg. 2019;45(3):291-4.
23. 23. Karatoprak K, Yaşar M, Hocaoğlu E, Mercan Sarıdaş F, Ateş C, Cander S, et al. Tip 2 diyabetli hastalarda SGLT2 inhibitörü tedavisinin hematolojik inflamatuar parametreler üzerine etkisi. Endokurs-7 Mezuniyet Sonrası Eğitim Kursu. 2023;47-9.